Misoprostol vs. oxytocin for induction of labor at term.

Efficacy of misoprostol was studied for induction of labor at term. Seventy patients were randomized to Group A (n = 36, oral misoprostol 50 microg four hourly to maximum of 5 doses) and B (n = 34, continuous oxytocin infusion). Induction-delivery interval was shorter with misoprostol (7.7 +/- 2.8 h against 14.3 +/- 4.8 h with oxytocin) but the rates of vaginal delivery, cesarean, neonatal outcome variables were similar. Hence, misoprostol is an effective agent for induction of labor at term.     

药物流产后阴道出血时间相关因素的定量研究

目的:了解影响药物流产后阴道出血时间的相关因素及其与出血时间的定量关系。方法:采用前瞻性的研究方法,共接纳合格妇女136人,对入选对象均进行全程随访。采用Cox回归,Kaplan-Meier方法进行分析。结果:11例因阴道出血时间过长(>14天)和(或)B超提示宫腔内组织物残留(平均径线>2.0cm)而行清宫术。Cox回归分析显示孕囊平均直径(GS)、药物流产后血β-hCG浓度及测定β-hCG的时间与药物流产后阴道出血时间有关。血β-hCG每增加1IU/L,持续出血的可能性为原来的1.0002倍;GS每增加1cm,持续出血的可能性为原来的1.596倍,按GS与药物流产后血β-hCG浓度分组比较,不同组之间药物流产后阴道出血时间有显著性差异(P<0.01)。结论:孕囊平均直径的大小对预测药物流产后阴道出血时间的作用较大,而药物流产后一次血β-hCG检测对预后的判断作用有限,有条件者应在流产前及流产后做血β-hCG动态测定,尤其是药物流产前血β-hCG的测定,对预测出血时间可能更有意义。停经天数不宜单独作为预测指标。     

米索前列醇单次剂量促宫颈成熟和引产76例

目的：探讨米索前列醇单次剂量促宫颈成熟作用。方法：选择宫颈评分≤6分，孕龄≥41周的足月孕妇146例，分为治疗组76例，将米索前列醇50 μg置于阴道后穹隆；对照组70例，给予安慰药。观察两组宫颈变化。结果：治疗组宫颈评分显著提高，促宫颈成熟有效率85.5%，高于对照组10.0%(P＜0.01)。用药至临产的时间(12.9±7.8) h，明显短于对照组(52.3±4.4) h(P＜0.01)，治疗组剖宫产率27.6%，明显低于对照组42.9%(P＜0.05)；两组新生儿APGAR评分差异无显著性(P＞0.05)，并未出现子宫收缩过频、胎心异常等不良反应。结论：米索前列醇50 μg单次剂量阴道内应用能有效使延期妊娠结束分娩，并能避免不良反应的发生。     

米索前列醇防治高危产后出血临床研究

目的 :观察口服米索前列醇用于预防高危产后出血的效果。方法 :将足月妊娠分娩有发生产后出血高危因素的产妇 98例随机分为 :①实验组 :5 0例 ,在胎儿娩出后立即口服米索前列醇 4 0 0 μg ,②对照组 :4 8例 ,在胎儿娩出后立即宫体内注射催产素 2 0U。产后 2 4h内平均出血量 ,试验组 (390± 6 2 .9)mL ,对照组 (435± 6 9.3)mL ,两组比较 ,P <0 .0 5。用药前后血压变化差异无显著意义。结论 :米索前列醇具有比催产素更强的子宫收缩作用 ,能很好地预防高危因素的产后出血 ,且用药方便、安全。     

异丙酚联合米索前列醇在人工流产术中应用研究

目的:探讨早孕妇女应用异丙酚行无痛人工流产术前阴道放置米索前列醇效果。方法:选择自愿行无痛人工流产术的早孕妇女240例随机分3组,于人工流产术前不同时间阴道放置米索前列醇(200μg)两组和对照组(未用米索前列醇),观察术中扩宫的难易程度、手术时间、术中出血量及手术并发症。结果:阴道放置米索前列醇组术中无阻力扩宫的例数均明显多于未放置米索前列醇组(P<0.01),手术时间亦明显缩短(P<0.01),术中出血量明显减少(P<0.01),麻醉药用量亦减少(P<0.01),术中反应少(P<0.01)。术前1～2小时阴道后穹隆放置米索前列醇组较术前3～4小时放药组术前腹痛率及阴道出血率均明显减少(P<0.01)。结论:术前1～2小时阴道后穹隆放置米索前列醇200μg可起到扩张宫颈,提高手术质量,减少手术并发症效果。     

Oral misoprostol in the third stage of labor.

OBJECTIVE: To compare the efficacy of intravenous ergometrine, intramuscular oxytocin, and oral misoprostol in the control of postpartum hemorrhage. METHODS: Mean blood loss, rates of blood loss between 500 and 1000 ml, hematocrit fall greater than 10%, and need for additional oxytocic agents and nature and rates of adverse effects were assessed in this prospective, randomized, controlled study. RESULTS: All outcomes were similar in the 3 groups. The main adverse effects in the misoprostol group were temperatures higher than 99 degrees F, which normalized within 2 h and shivering, which was mild and self-limiting. CONCLUSIONS: Oral misoprostol is as effective as conventional oxytocic agents in preventing postpartum hemorrhage and can be recommended for use in low-resource settings.     

Oral misoprostol for prevention of postpartum hemorrhage by paramedical workers in India.

OBJECTIVE: To study whether paramedical workers from rural primary health centers in India are able to administer oral misoprostol and actively manage the third stage of labor to prevent postpartum hemorrhage (PPH). METHOD: Cluster randomization was used to enroll 1200 women at 30 peripheral health centers from 5 states in India, 600 forming the study's intervention group (active management of the third stage of labor with 600 mug of oral misoprostol) and 600 forming the comparison group (in which the current government guidelines for the prevention of PPH were followed). The primary outcome was blood loss after delivery, which was measured using a calibrated blood collection drape. RESULTS: Age, literacy level, occupation, and gravidity were similar in the 2 groups. More than 70% of women in both groups had moderate anemia (hemoglobin level <10 g/dL). Paramedical workers followed instructions in almost all deliveries in the intervention group (99%). There was a significant reduction in duration of the third stage of labor (7.9 +/- 4.2 min vs. 10.9 +/- 4.3 min; p < .001) and median blood loss after delivery (100 mL vs. 200 mL; p < .001) in the intervention group. Overall, a low incidence of PPH was observed (<1%) in both groups. A greater number of women had moderate to severe shivering (12.7% vs. 0.5%) and a temperature higher than 38 degrees C (9.7% vs. 4.3%) in the intervention group, which was statistically significant. CONCLUSION: Simple interventions can be easily implemented in rural health care settings to reduce the blood loss during labor. This finding has significant implications for developing countries, in which the prevalence of anemia is high.     

口服米索前列醇用于早期妊娠人工流产术前扩张宫颈的有效性和安全性评价

目的:系统评价口服米索前列醇与安慰剂比较用于孕早期人工流产术前扩张宫颈的有效性和安全性。方法:检索相关文献并行Meta分析。据异质性检验结果采用固定效应模型、敏感性分析或随机效应模型等处理。结果:纳入文献5篇688例,国外文献质量高于国内。口服米索前列醇较之安慰剂宫颈扩张度好的比例较高,可降低术中出血量及疼痛发生率;在人工流产综合征(PAAS)、胃肠道副反应和用药后腹痛发生率及手术时间上两者差异无统计学意义。结论:国内原始研究质量有待提高,结局指标需更加规范。口服米索前列醇对于扩张宫颈有较好临床效果,而在其他有效性指标方面效果不明显,其安全性有待更多证据加以评价。     

米索前列醇用于晚期妊娠引产的现况和进展

米索前列醇用于晚期引产效果肯定,但安全性仍不能令人满意。本文综合近年来的文献,就米索前列醇与其他常用引产药物的效果和安全性比较,米索前列醇的用药途径、用药剂量、用药间隔,与米非司酮配伍的应用现况等方面作一综述。     

戊酸雌二醇配伍药物流产在早中期妊娠引产中的疗效观察

目的探讨戊酸雌二醇联合米非司酮和米索前列醇终止10～20周早中期妊娠的临床疗效。方法对146例妊娠10～20周要求终止妊娠的孕妇以戊酸雌二醇联合米非司酮和米索前列醇引产。观察胚胎排出时间、胚胎流产情况、产后出血量及药物不良反应。结果 146例孕妇用药24h后,妊娠物排出者144例(98.6%),仅2例(1.4%)无任何妊娠物排出。完全流产124例(84.9%),不全流产20例(13.7%),失败2例(1.4%)。出血量为5～20ml,无大出血发生。不良反应均轻微,无需处理。结论戊酸雌二醇联合米非司酮和米索前列醇终止10～20周妊娠简便、安全、有效,具有胃肠道不良反应轻、引产时间短、出血量少、组织残留率低、并发症少、成功率高等优点,值得临床推广应用。